Herpes stomatitis in children is an acute inflammatory lesion of the oral mucosa caused by the herpes simplex virus. Herpes stomatitis in children is manifested by fever, lymphadenitis, salivation, nausea, blistering rashes, erosions and canker sores in the oral cavity, loss of appetite. The diagnosis of herpetic stomatitis in children is based on the medical history, clinical picture, cytological examination, RIF, PCR, ELISA. Treatment of herpetic stomatitis in children includes antiviral, desensitizing, immunocorrective therapy, local treatment of the oral cavity, physiotherapy.
Herpes stomatitis in children
Herpetic stomatitis in children – a herpes virus infection that occurs with a primary lesion of the oral mucosa and the symptoms of poisoning. In pediatrics and pediatric herpetic stomatitis among the inflammatory oral diseases in children, a share of almost 80% of the cases has been classified. Herpetic stomatitis is considered a manifestation of the child’s body’s first contact with the herpes simplex type I virus. The most common herpetic stomatitis in children from 1 to 3 years, due to their age and morphological features, the reduction of transplacental antibodies and cellular immaturity and specific immunity. Herpes stomatitis can be observed in children of the first year of life, from the first months artificial feeding.
There are two types of herpes stomatitis in children: primary acute and chronic recurrences. Children who have recovered from acute herpetic stomatitis become asymptomatic virus carriers or suffer from a chronic infection. Herpetic stomatitis in children can be associated with damage to the nervous system and internal organs, suppression of immune reactions and therefore requires great attention from pediatricians, pediatric dentists, children’s immunologists, pediatric neurologists and other specialists.
Causes of Herpetic Stomatitis in Children
HSV Type I – DNA virus belongs to the herpesviridae family and clinically manifest rash on the face and oral mucosa. Once in the child’s body, HSV actively multiplies in epithelial cells and the surrounding lymph nodes (frequently, submaxillary) enters the bloodstream (primary viremia) and from there to the various organs (liver, spleen, etc.), followed by breeding and secondary viremic. In the next phase it is skin lesions and the mucous membranes of the lips, mouth and throat with the development of symptoms in children with herpetic stomatitis. Herpes infection is able to pass into a latent form with a lifelong persistence of the virus in the nerve ganglia.
The source of the pathogen are children with acute herpetic stomatitis, adults with recurrent herpes of the lips and virus carriers. Herpetic stomatitis is very contagious: I can HSV type on healthy Children are transmitted without contact to the household (by kissing, toys, household items) and by droplets (coughing and sneezing), possible vertical transmission from the mother to the fetus (for recurrent herpes with viraemia in a pregnant woman).
Recurrences of chronic zoster stomatitis in children occur on the background of immunosuppression under the influence of provoking factors: hypothermia, overheating, prolonged exposure to the sun, stress, lack of vitamins, the high doses of antibiotics, through SARS. Most often, herpes stomatitis in children is observed in spring-autumn.
Symptoms of herpetic stomatitis in children
Depending on the clinical symptoms, herpetic stomatitis can occur in a child in mild, moderate and severe forms; in its development was isolated incubation prodromal stage, the level of the disease (catarrhal, rash period), the extinction time and clinical recovery. Children have mild and moderate forms of herpes stomatitis more often.
The latency period of herpetic stomatitis in children is 2 to 14 days. In the prodromal period, the child becomes restless, moody, crying, refuses to eat, does not sleep well. Salivation, nausea, vomiting, increase and pain in the mandibular and cervical lymph nodes are noted.
Herpetic stomatitis in children usually begins with fever (up to 38-40 ° C), a worsening of the general condition. In the middle of the disease, catarrhal symptoms close: acute gingivitis, runny nose, cough and sometimes conjunctivitis. His gums are hyperemic, swollen, bleeding. On the oral mucosa, single or vesicular rashes appear in the form of thin-walled bladder sizes of 2-3 mm, which are grouped with the formation of painful erosions and aphthae (flat ulcers covered with whitish bloom) slightly open. Herpes eruptions are most common on the gums, firm and soft sky, the back of the tongue, cheeks and lips.
The formation of vesicles takes 2-4 days and is accompanied by severe pain. At the same time, rashes can be observed at various stages of development. Aphids and erosions are gradually eliminated and tightened without scarring. In herpes stomatitis, children are characterized by a wavy course: the appearance of rashes with fever ends with a short period of stall, then a new rash wave begins with a further jump in temperature.
With reduced immunity and the attachment of a secondary bacterial infection, pustular lesions of the mucous membrane and skin appear. Acute herpetic stomatitis in children can last 7 to 14 days, depending on the severity and duration of treatment. Dangerous for acute HSV infection can in the first months of life due to the generalization of the lesion, the risk of septic conditions, involvement of internal organs, serous membranes of the brain.
Diagnosis of herpetic stomatitis in children
The diagnosis of herpetic stomatitis in children is based on a clinical picture, anamnesis, the results of cytological, virological and serological studies.
To identify the virus, you can use blood serum, saliva, smears, douches, or scrapings from the oral mucosa. To establish the causative agent of herpetic stomatitis in children, it is possible using immunofluorescence (RIF) and PCR. The serological identification of the titer of the viral antibodies is carried out using ELISA and DSC.
Herpetic stomatitis in children must be distinguished from other types of stomatitis (allergy, medication, fungus), herpes angina, specific infections (measles, scarlet fever, chickenpox, diphtheria), erythema multiforme exudative.
Treatment of herpetic stomatitis in children
In the uncomplicated course of herpetic stomatitis, outpatient treatment, in complicated cases and in children of the first three years of life, may require hospitalization. Children with herpetic stomatitis are presented as bed rest, copious drink, pureed, warm, non-irritating food, use of separate utensils and hygiene articles.
The complex treatment of herpetic stomatitis in children (general and local) is selected depending on the duration of the disease and the severity of the symptoms. With fever and pain, acetaminophen, ibuprofen; to remove edema – antihistamines (mebhydroline, clemastine, hifenadine). Systemic etiotropic therapy (acyclovir, interferon) is more effective in the initial phase. Lysozyme, thymus extracts and gamma globulin injections are prescribed for the purpose of immunocorrection.
The local treatment of herpetic stomatitis in children is carried out by a pediatric dentist and a pediatric dentist. Daily treatment of the oral mucosa with antiseptics, anesthetics, decoctions of herbs, lubrication with antiviral drugs is carried out. In the moderate form of herpes stomatitis in children, solutions of proteolytic enzymes (trypsin, chymotrypsin) are used to clean the surface of the mucous membrane from necrotic masses.
Keratoplastic agents (vitamins A, E, rosehip oil and sea buckthorn) are used in the epithelialization of erosions. Physiotherapy with herpetic stomatitis in children is prescribed from the first days of illness (UV, infrared). With recurrent herpetic stomatitis, children are shown courses of strengthening medications (vitamin C, B12, fish oil), high-calorie diet.
Prognosis and prevention of herpetic stomatitis in children
Herpes stomatitis in children in most cases leads to clinical recovery after 10-14 days. In severe cases, there is a risk of complications in the form of herpetic keratoconjunctivitis, herpes encephalitis, generalization of the infection.
Infection is impossible to prevent children from coming into contact with herpes virus because the transport of HSV among the adult population is 90%. Prevention of herpes stomatitis can include isolation of the sick child from healthy children, border contact with adults in the active phase of the infection, personal hygiene, hardening, physical education.
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